Epidemiological and genetic analyses of Hepatitis C virus transmission among young/short- and long-term injecting drug users from Rio de Janeiro, Brazil.

BACKGROUND: Injecting drug users (IDU) have a key role in Hepatitis C Virus (HCV) epidemiology. Young/short-term IDUs constitute a target group for preventive/harm reduction interventions. OBJECTIVES: To investigate HCV transmission among young/short-term (ST) and long-term (LT) IDUs, from the perspective of epidemiology and molecular biology. STUDY DESIGN: Cross-sectional study assessing the prevalence of HCV infection/genotypes, as well as risk behaviours/practices among IDUs from Rio de Janeiro. Phylogenetic analyses were performed and the extent of segregation between sequences was quantified by the Association Index. RESULTS: ST were more likely to engage into needle-sharing (p=.021) and LT to attend Needle Exchange Programs (p=.006). HCV prevalence was 10.1% vs. 23.4% among initiates and LT, respectively (p<.001). Older age vs. imprisonment and longer duration of IDU career were independent predictors for HCV infection among ST and LT, respectively. Among the latter, NEP attendance was inversely associated with viral infection. HCV3a infections were the most prevalent. A moderate extent of phylogenetic segregation between sequences was found, suggestive of transmission between IDU subgroups. CONCLUSIONS: The lower HCV prevalence among young/short-term IDUs cannot be viewed with complacency, due to their frequent engagement into direct/indirect sharing practices and the ongoing transmission between IDU subsets. To avert new infections, preventive/harm reduction policies must be tailored to empirical findings.

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil.

The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.

"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil

O trabalho investiga o contexto da primeira injecão de drogas e sua associacão com práticas atuais de injecão e infeccão pelo HCV (vírus da hepatite C). Usuários de drogas injetáveis (UDI) (N = 606) foram recrutados em cenas de uso (ruas, bares) do Rio de Janeiro, Brasil, entrevistados e testados (anti-HCV). A freqüência de compartilhamento de agulhas e seringas foi superior na primeira injecão (51,3 por cento), se comparada à atualmente referida (36,8 por cento). Usuários que iniciaram o uso injetável compartilhando agulhas/seringas relataram uma freqüência significativamente maior de compartilhamento direto/indireto de agulhas/seringas nos últimos seis meses. A infeccão pelo HCV foi quatro vezes mais prevalente entre UDI jovens (< 30 anos) que compartilharam agulhas e seringas na primeira injecão. A prevalência de anti-HCV foi 11 por cento entre UDI ativos (n = 272) e se mostrou independentemente associada à história de prisão e à duracão do uso de drogas injetáveis. A prevencão da disseminacão do HCV nesta populacão requer a adocão de medidas de reducão de riscos e danos associados à injecão de drogas já desde a primeira injecão ou, antes, um desestímulo à transicão do uso não injetável para injetável.

The role of "long-term" and "new" injectors in a declining HIV/AIDS epidemic in Rio de Janeiro, Brazil.

BACKGROUND: A substantial decline of HIV prevalence has been observed in injection drug users (IDUs) from Rio de Janeiro, in recent years. Differential characteristics and behaviors of new (injecting for <6 years) and long-term (>=6y) injectors may help to understand recent changes and to implement appropriate prevention strategies. METHODS: Between October 1999 and December 2001, 609 active/ex-IDUs were recruited from different communities, interviewed, and tested for HIV. Contingency table analysis and t-tests were used to assess differences between new and long-term injectors. Multiple logistic regression was used to identify independent predictors of HIV serostatus for long-term and new injectors. RESULTS: HIV prevalence was 11.7% for 309 long-term injectors (95% CI 8.1-15.3) and 4.3% for 300 new injectors (95% CI 2.0-6.6). New injectors reported having engaged in treatment and having received syringes from needle exchange programs (NEPs) more frequently than long-term injectors in the last 6 months, but sharing behaviors remained frequent and even increased vis-à-vis long-term injectors. For male new injectors, "sexual intercourse with another man" was found to be the sole significant risk factor for HIV infection (Adj OR = 8.03; 95% CI 1.52-42.48). Among male long-term injectors, "to have ever injected with anyone infected with HIV" (Adj OR = 3.91; 95% CI 1.09-14.06) and to have "ever been in prison" (Adj OR = 2.56; 95% CI 1.05-6.24) were found to be significantly associated with HIV infection. DISCUSSION: New injectors are seeking help in drug treatment centers or needle exchange programs. They differ from long-term injectors in terms of their risk factors for HIV infection and have lower prevalence levels for HIV. Such differences may help to understand the recent dynamics of HIV/AIDS in this population and highlight the need to reinforce new injectors' help-seeking behavior and to reduce current unacceptably high levels of unprotected sex and syringe sharing in new injectors despite attendance of prevention/treatment programs.

Primeira injeção de drogas e hepatite C: achados preliminares / The first drug injection and hepatitis C: preliminary findings

Investigou-se o contexto da primeira injeção de drogas e sua possível associação com a infecção pelo vírus da hepatite C (HCV). Usuários de drogas injetáveis (UDI) – N=606 – foram recrutados em “cenas de uso” no Rio de Janeiro, Brasil. Os voluntários foram entrevistados e testados para a presença de anti-HCV. A utilização anterior, não injetável, da mesma droga injetada (basicamente cocaína) foi relatada por 92,0% dos UDI (último mês), administrada semanal/diariamente (86,2%). O primeiro injetador foi um amigo próximo (51,7%), utilizando uma seringa/agulha usada (51,5%), e as drogas foram obtidas como “presente” em 40,0% dos casos. Cerca de 68,0% dos UDI introduziram novos usuários: 88,1% iniciaram um a cinco outros indivíduos. A prevalência de anti-HCV foi menor entre injetadores que iniciaram o uso de drogas após 1980. Visando controlar a infecção pelo HCV nessa população, as estratégias voltadas à prevenção/redução de danos deveriam considerar distintos cenários e gerações de usuários, desde a primeira injeção...

HIV-1 infection among injection and ex-injection drug users from Rio de Janeiro, Brazil: prevalence, estimated incidence and genetic diversity.

BACKGROUND AND OBJECTIVES: Due to their behavioral conditions and vulnerability, injection drug users (IDUs) are prone to multiple simultaneous or sequential infections with distinct HIV-1 subtypes and variants, making them a key population for molecular epidemiology surveillance. In the present study, we evaluated HIV-1 infection seroprevalence, genetic diversity and estimated incidence among IDUs and ex-injection drug users (ex-IDUs) from Rio de Janeiro, Brazil. STUDY DESIGN: Six hundred and eight IDUs and ex-IDUs, recruited between 1999 and 2001, were interviewed and agreed to donate 30 ml of blood. The serologic status for HIV infection was determined by two ELISAs and confirmed by IFA. CD4+ T-cell percentages were assessed by flow cytometry. HIV-1 positive samples were submitted to viral load quantification. DNA samples were PCR amplified and HIV-1 subtypes were determined using env and gag HMA. RESULTS AND CONCLUSIONS: Forty-eight (7.89%) individuals were seropositive for HIV-1 infection. The seroincidence of HIV-1 infection was estimated as 0.76%. HIV-1 env and gag subtyping identified 29 (69%) samples as belonging to subtype B, 7 (16.7%) to subtype F, and 6 (14.3%) discordant env/gag genomes infections, indicating the circulation of recombinant viruses in this population.

Infecção pelo HIV e HTLV e Hepatites virais entre UDIs no Rio de Janeiro / HIV Infection and HTLV and viral hepatitis among UDIs in Rio de Janeiro

Procura caracterizar os usuários de drogas injetáveis em suas comunidades e definir fatores de risco para infecções pelo HIV, HTLV I/II e hepatites virais entre usuários de drogas injetáveis no Rio de Janeiro (DV)

Infecçäo pelo HIV entre usuários de drogas injetáveis: análise dos fatores de risco no Município do Rio de Janeiro, Brasil / HIV-infection among injecting drug users: analysis of risk factors in Rio de Janeiro city, Brazil

Determina os fatores de risco para a infecção pelo HIV entre usuários de drogas injetáveis. O estudo consistiu de 110 entrevistados que voluntariamente realizaram testes laboratoriais para a presença do HIV, além de outros agentes infecciosos de transmissão sanguínea. A soroprevalência para o HIV - 1 foi de 28,7 por cento. Foram relacionados todos os fatores de risco identificados

A epidemia de AIDS no Brasil

Análise da dinâmica da epidemia de AIDS no Brasil a partir dos casos notificados e seu impacto segundo os indicadores sócio-demográfico. (JSL)

O Nao-dito da AIDS / The Hidden face of AIDS in Brazil

Historiam a evoluçao da epidemia de AIDS no Brasil do ponto de vista da construçao de representaçoes sociais acerca dos segmentos envolvidos na transmissao da doença. Enfatizam a necessidade de desmistificar a correlaçao simplista AIDS-transmissao homossexual. Procuram retirar do relativo esquecimento o papel dos usuários de drogas injetáveis e da transmissao heterossexual na disseminaçao da doença, "segmentos" cuja relevância epidemiológica,crescente em nosso meio, nao se tem feito acompanhar da devida atençao, seja porparte dos meios de comunicaçao, seja pelos orgaos formuladores de políticas de saúde (AU)

O Nao-dito da AIDS / The Hidden face of AIDS in Brazil

Historiam a evoluçao da epidemia de AIDS no Brasil do ponto de vista da construçao de representaçoes sociais acerca dos segmentos envolvidos na transmissao da doença. Enfatizam a necessidade de desmistificar a correlaçao simplista AIDS-transmissao homossexual. Procuram retirar do relativo esquecimento o papel dos usuários de drogas injetáveis e da transmissao heterossexual na disseminaçao da doença, "segmentos" cuja relevância epidemiológica,crescente em nosso meio, nao se tem feito acompanhar da devida atençao, seja porparte dos meios de comunicaçao, seja pelos orgaos formuladores de políticas de saúde